Surgeon John Peter Mettauer published an article describing surgeries he had undertaken to relieve the occurance of vesico-vaginal fistula in two subjects: one a 34-year old woman, and the other a 20-year old woman, described as a servant and presumably enslaved. In his article, Mettauer describes operating on the latter woman at least eight times, at least twice a year, until he "relinquished the case." Though Mettauer considered the surgical procedure on the 34-year old woman successful, all of the operations on the 20-year old woman ended in failure, which Mettauer attributed to "sexual intercourse" which he believed "defeated several of the operations."